Diagnostic yield of repeat screening colonoscopy ten years after an adenoma-negative index screening endoscopy

Abstract

In Germany, colonoscopy was introduced as a screening instrument about 20 years ago. Ten years after an adenoma-negative index endoscopy, a second screening colonoscopy can be performed in younger persons, but this approach is based on limited evidence. We therefore prospectively analyzed the diagnostic yield of second screening colonoscopies in clinical routine.

Ten years following adenoma-negative screening endoscopy a second screening colonoscopy was performed in 401 persons (210 women and 191 men); mean age was 70 years. A total of 244 benign neoplastic lesions were removed in 135 persons (34%). Eight persons had three or more small tubular adenomas removed; 19 persons had at least one tubular adenoma measuring ≥ 10 mm; 14 persons had adenomas with villous characteristics; 19 persons had serrated adenomas; one person had an adenoma with high grade dysplasia. Thus 61 persons (33 men and 28 women) were classified as bearing a significant risk for the development of colorectal cancer (15%). An additional patient had a low-risk malignant polyp removed endoscopically.

We conclude that a significant number of small and advanced adenomas can be identified in a second screening colonoscopy ten years after an adenoma-negative index screening endoscopy, but malignant lesions are rare. Whether or not removal of the benign lesions in a second screening colonoscopy will reduce incidence and mortality of colorectal carcinoma remains to be seen in this elderly group.

Zusammenfassung

Vor etwa 20 Jahren wurde die Vorsorge-Koloskopie in Deutschland eingeführt. 10 Jahre nach einer Adenom-freien Untersuchung sieht dieses Konzept bei jüngeren Personen eine weitere Koloskopie vor. Da zu diesem Ansatz nur wenige Daten verfügbar sind, untersuchten wir prospektiv die Ergebnisse einer zweiten Vorsorge-Koloskopie in der klinischen Routine.

10 Jahre nach einer ersten Adenom-freien Vorsorge-Endoskopie erfolgte eine zweite Vorsorge-Koloskopie bei 401 Personen mit einem mittleren Alter von 70 Jahren (210 Frauen und 191 Männer). Bei 135 Personen (34%) wurden insgesamt 244 Adenome entfernt. 8 von ihnen hatten 3 oder mehr Adenome unter 10 mm; 19 hatten mindestens ein Adenom von ≥ 10 mm Durchmesser; 14 Personen hatten Adenome mit villöser Histologie; 19 hatten serratierte Adenome; einer hatte ein Adenom mit einer hochgradigen Dysplasie. Insgesamt trugen 61 Personen (33 Männer und 28 Frauen) ein signifikantes Risiko, ein kolorektales Karzinom zu entwickeln (15%). Bei einem weiteren Patienten wurde ein low-risk maligner Polyp endoskopisch entfernt.

Somit wurde 10 Jahre nach einer Adenom-freien ersten Vorsorge-Endoskopie bei einer zweiten Vorsorge-Koloskopie eine signifikante Zahl an kleinen und fortgeschrittenen Adenomen entfernt, aber nur eine einzige maligne Läsion. Ob in dieser Gruppe älterer Personen eine zweite Vorsorge-Koloskopie mit Entfernung neoplastischer Läsionen die Inzidenz und Mortalität des kolorektalen Karzinoms senkt, bleibt unklar.

Schlüsselwörter

Vorsorgeuntersuchung - Koloskopie - Adenomerkennung - Kolorektalkarzinom

Keywords

screening - colonoscopy - adenoma detection - colorectal carcinoma

Publication History

Received: 13 October 2021

Accepted after revision: 11 March 2022

Article published online:
09 May 2022

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